Plan To Rewrite Rules On Organ Transplants Debated

WASHINGTON — Peggy Drecker's son, Daniel, was only 6 weeks old when she learned he had liver disease that only a transplant could cure.

So Drecker quit her job and took Daniel from their home in Kearny, N.J., to Pittsburgh, which had a more effective transplant program at that time. She had to return when the first was unsuccessful.

Thirteen years later, Daniel is healthy. New Jersey has an effective pediatric transplant program, and Peggy Drecker says she opposes a government plan to rewrite the regulations governing organ transplants.

``This [program] works for us in New Jersey,'' she said. ``Please don't let it be taken away by these new regulations.''

Health and Human Services Secretary Donna E. Shalala said her department proposed the regulations in April to eliminate wide disparities in the time patients spend waiting for organ transplants.

Shalala's new rules call for a nationwide standard that gives highest priority to medical necessity in assigning organs. Currently, organs are made available first in the area in which they are collected.

The regulations, scheduled to go into effect Oct. 1, came under close scrutiny Thursday as two congressional committees tried to determine whether they would produce a fairer transplant system for Americans, as the government contends, or lead to problems that worry Drecker and others.

The outcome could not be more important. ``Today's discussion of organ allocation will determine who lives and who dies,'' said Sen. Bill Frist, R-Tenn., a transplant surgeon and a member of one of the committees. The government estimates 10 people die every day waiting for a transplant.

Critics said the regulations could destroy a system that works well.

The proposal has caused divisions among members of Congress, medical experts and transplant organizations and has opened a deep rift between Shalala's department and the organization it contracts with to operate the transplant system in accordance with legislation Congress approved in 1984.

Nothing in present regulations prevents people such as Peggy Drecker from traveling areas that specialize in transplants and may have more organs available as a result. But Rep. Louis Stokes, D-Ohio, said the current system is unfair to minorities because they often cannot afford such trips.

Shalala said she wants to correct that problem. ``I have a deep concern that today people are dying simply because of where they live,'' she said. For example, she said, patients typically wait 648 days for a liver transplant in Massachusetts but only 54 days in Wisconsin.

Currently, more than 56,000 people are on transplant waiting lists across the country and the demand is expected to grow.

``We need a level playing field so that the same medical criteria are used for all patients and so that organs are allocated according to medical need,'' Shalala said.

The strongest opposition comes from Lawrence G. Hunsicker, president of the United Network for Organ Sharing, or UNOS, a Virginia-based organization that operates the transplant program under a government contract.

``We strongly object to the policy-making decisions being taken out of the hands of the transplant community,'' Hunsicker said.

He asserted Shalala's proposal would lead to more deaths among transplant patients, longer average waiting times, closing of smaller transplant centers and higher costs to the federal government.

Shalala received strong backing from the Transplant Recipients International Organization, a patient advocacy group. President Bruce Weir said the new rules would go ``a long way in meeting our goal of putting patients first.''